真性左束支传导阻滞心电图特征与慢性稳定型心力衰竭治疗效果的相关性分析

Correlation between the characteristics of true LBBB electrocardiogram and the therapeutic effect of chronic stable heart failure

目的探讨真性左束支传导阻滞(t-LBBB)心电图特征与慢性稳定型心力衰竭治疗效果的相关性.方法回顾性分析2013年1月至2017年12月在本院确诊为慢性心力衰竭且接受心脏再同步化(CRT)治疗的65例患者临床资料.依据其12导联心电图中QRS波宽度、波形等信息将入选者分为t-LBBB(观察组,38例)和无LBBB(n-LBBB者(对照组,27例).对比2组术后随访1、6、12个月心力衰竭重建指标[心率、QRS波宽、左室射血分数(LVEF)、左室舒张末期内径(LVEDd)、纽约心脏病学会心功能分级(NYHA)]和末次随访时CRT应答情况.采用多因素COX回归分析法分析影响CRT应答性的独立因素.结果重术后随访1、6、12个月,2组心率、QRS波宽、LVEF、LVEDd、NYHA均发生明显改变(P<0.05);观察组随访1、6、12个月时心率、QRS波宽、LVEDd、NYHA均低于对照组,LVEF高于对照组(P<0.05).随访时,观察组CRT应答人数明显多于对照组(P<0.05).COX回归分析显示,术前缺血性病因、肾小球滤过率与心力衰竭患者术后应答呈负相关,t-LBBB与心力衰竭患者术后应答呈正相关.结论t-LBBB心电图特征可作为预测慢性心力衰竭心室同步化运动治疗效果的保护性因素.

Objective To investigate the correlation between the electrocardiographic features of true(left bundle branch block,t-LBBB)and the treatment of chronic stable heart failure(chronic heart failure).Methods The clinical data of 65 patients who were diagnosed as chronic heart failure and received cardiac resynchronization(CRT)in our hospital from January 2013 to December 2017 were retrospectively analyzed.According to the QRS wave width and wave form in the 12-lead ECG,the subjects were divided into t-LBBB(observation group,38 cases)and n-LBBB(control group,27 cases).The scores of heart failure reconstruction(heart rate,QRS width,LVEF,LVEDd,NYHA)and CRT response at the last follow-up were compared between the two groups after 1,2,and 12 months of follow-up.Multivariate COX regression analysis was used to analyze independent factors affecting CRT responsiveness.Results Repeated measures analysis of variance showed that heart rate,QRS width,LVEF,LVEDd,and NYHA were significantly changed in the follow-up at 1,6,and 12 months after surgery(P<0.05).The heart rate,QRS width,LVEDd and NYHA in the observation group were lower than those of the control group in the follow-up at 1,6,and 12 months after surgery,and LVEF was higher than that of the control group(P<0.05).At the last follow-up,the number of CRT responses in the observation group was significantly higher than that in the control group(P<0.05).COX regression analysis showed that preoperative ischemic etiology,glomerular filtration rate was negatively correlated with postoperative response in patients with heart failure,and t-LBBB was positively correlated with postoperative response in patients with heart failure.Conclusion The t-LBBB electrocardiographic features can be used as a protective factor to predict the effect of ventricular synchronized motion in chronic heart failure.